Janet Gulla

Pediatric first aid knowledge among parents

Objective: The American Academy of Pediatrics (AAP) has published simple guidelines for the first aid management of ill or injured children. We determined knowledge of these first aid practices in parents. Methods: Design-Descriptive survey. Participants-A convenience sample of adult parents presenting to the emergency department. Survey instrument-Standardized collection of demographics was performed and adults were given a multiple-choice questionnaire concerning the proper management of stings and bites, burns and scalds, eye injuries, fractures and sprains, fever, head injuries, fainting, poisoning, dental emergencies, nosebleeds, seizures, and skin wounds. Outcomes-Percentage of adults responding to questions appropriately based on AAP guidelines. Data analysis-Descriptive statistics and χ2 tests. Results: Six hundred fifty-four adults were surveyed. Mean age (SD) was 38.5 (13.8), 56% were female, 69% were white, 56% had at least a high school education. None of those surveyed answered all questions correctly with roughly half being familiar with 60% of the questions. Knowledge of specific guidelines ranged from 21% to 92%. Subjects especially lacked knowledge regarding the need to rapidly remove all bee stingers (only 36% aware); keep wounds moist and covered (79% felt that drying wounds was beneficial); the need to cover victims of large burns (only 43% aware); and the need to seek medical attention after tick bites (only 47% aware). Knowledge was unaffected by age, gender, and education. Conclusions: Many adults are unfamiliar with AAP first aid measures according to the AAP guidelines and most believe that wounds should be allowed to dry. Further education is required to improve knowledge of first aid practices.

Evaluation of a New High-viscosity Octylcyanoacrylate Tissue Adhesive for Laceration Repair: A Randomized, Clinical Trial

OBJECTIVE Tissue adhesives have recently been approved for skin closure. Their low viscosity may result in inadvertent migration. The authors compared the tendency of the adhesive to migrate after laceration closure with a high- or low-viscosity octylcyanoacrylate (OCA). METHODS This was a randomized, clinical trial set in university and community-based emergency departments. Participants included patients with simple traumatic lacerations. Patients were randomized to laceration closure with low- or high-viscosity OCA tissue adhesive. The outcome measured was immediate adhesive migration (interobserver agreement, kappa = 0.90). Data analysis was performed with proportions compared with chi-square and Fishers exact tests. RESULTS Eighty-four patients were randomized to low- (n = 42) or high- (n = 42) viscosity OCA tissue adhesive. Groups were similar in baseline patient and wound characteristics. The high-viscosity OCA was less likely to migrate than the lower-viscosity agent (21% vs. 78%, p < 0.001; odds ratio = 0.3, 95% confidence interval = 0.1 to 0.5). The proportion of patients who noted a sensation of heat during OCA application was higher in the high-viscosity groups (44% vs. 26% respectively, p = 0.11); however, all such patients in both groups would use the device again. At 14 days, there were no wound infections in either group. There was one dehiscence in the high-viscosity group. CONCLUSIONS The high-viscosity OCA tissue adhesive was less likely to migrate than the lower-viscosity device. Wound dehiscence and infection rates were acceptably low in both treatment groups.

Long HIV-1 incubation periods and dynamics of transmission within a family.

The incubation period of human immunodeficiency virus type 1 (HIV-1) infection was studied in a family of five in which vertical and heterosexual transmission occurred from one index case. This investigation documented incubation periods of longer than 12 years in a mother and her daughter; although neither has symptoms, both are definitely infected and have very low CD4(+)-lymphocyte counts. The study confirmed the predictions of incubation periods longer than 10 years in a small proportion of infected individuals. It provides evidence that vertically HIV-1-infected teenagers can be expected to appear in the population.

Single-layer versus double-layer closure of facial lacerations: a randomized controlled trial.

Background: The objective of this study was to compare the cosmetic outcome of facial lacerations closed with a single or double layer of sutures. Methods: Patients aged 1 year or older presenting to a university-based emergency department with nongaping (width, <10 mm), simple, nonbite, facial lacerations were randomized to closure with a single layer of simple interrupted 6-0 polypropylene sutures or a double layer of simple interrupted 6-0 polypropylene plus inverted deep dermal 5-0 polyglactin sutures. At 90 days, the scar width and cosmetic appearance were determined using a validated 100-mm visual analogue scale ranging from 0 (worst) to 100 (best) and a validated wound evaluation score ranging from 0 (worst) to 6 (best). Results: Sixty-five patients were randomized to single-layer (n = 32) or double-layer (n = 33) closure. Mean age (SD) was 18.5 years (20.0), and 14 percent were female. Groups were similar in baseline patient and wound characteristics. Length of single-layer closure was 7 minutes shorter (95 percent CI, 2 to 11 minutes) than double-layer closure. There were no infections or dehiscences in either group. There were no between-group differences in patient (mean difference, 0.5 mm; 95 percent CI, –5.7 to 6.6 mm) or practitioner (mean difference, 1.0 mm; 95 percent CI, –4.8 to 6.7 mm) visual analogue scale scores. All but one patient had an optimal wound evaluation score of 6 (p = not significant). Scar width was similar at 90 days (mean difference, 0.2 mm; 95 percent CI, –0.05 to 0.5). Conclusions: Single-layer closure of nongaping, minor (<3 cm) facial lacerations is faster than double-layer closure. Cosmetic outcome and scar width are similar in sutured wounds whether or not deep dermal sutures are used.

Efficacy of rifabutin in the treatment of AIDS-related complex.

We performed a phase 1–2 antiviral dose escalation trial of rifabutin, a rifamycin antibiotic with anti-HIV-1 activity in vitro. We followed 16 men with AIDS-related complex (ARC) for a mean duration of 29 weeks; the maximum toxicity-limited dose of rifabutin was 2400 mg/day, which was achieved in two patients. There was some evidence of anti-HIV-1 activity in two patients, one of whom had an improvement in immune status, but 11 of the 16 patients showed a deterioration in either virologic or immunologic status. The majority of the patients under study remained clinically stable during the trial, but there was clinical deterioration in the three who entered with CD4 cell counts of less than 100 x 106/l. On the basis of this trial, rifabutin as a single antiviral agent does not appear to be beneficial to ARC patients.